SOME NEW ESSAYS

Dear Friends,

In the last month or more I have started blogging on Medium.  Here are three new essays that
you might find of interest.

If you are going to comment, and please do, it would be helpful to have a name, or at least initials and if you have a website, the URL so I can respond appropriately..  Anonymous comments often get marked as spam.  Particularly if they sound and look like spam!

Here are the Medium posts:

https://medium.com/@maybenatar/childhood-sexual-abuse-a-neglected-public-health-issue-7cb71ab7f97f

https://medium.com/@maybenatar/sarah-silverman-shows-us-how-to-respond-from-our-wisest-parts-88bdcb09c183

https://medium.com/@maybenatar/trauma-memory-and-flashback-1808365dc6af

Thanks all.

BTW I have a book coming out in late March: Emma and Her Selves: A Memoir of a Treatment and a Therapist's Self Discovery..  More on the book later.

Below is a link to my thoughts on a recent article in THE NEW YORK TIMES about self- help groups for individuals who hear voices.  I thought the article did not cover all bases.

Please let me know what you think about it, maybe on the Huffington Post's comment page.

Thanks for reading.

http://www.huffingtonpost.com/entry/listening-to-muted-voices_us_57bf2a76e4b0b01630de01a1?

How I became a trauma therapist 

may benatar

For two years I spoke to a nearly mute woman.  Much of the time I was just trying to guess what she was feeling and reflecting it  back to her.  I just talked.  I didn’t really know what was wrong.  I knew that she had a history of sexual abuse but I did not know who had abused her, the nature of the abuse, or details of the family she came from. I had only the vaguest notion what the issues were for her or why she wouldn’t talk.  I didn’t know what she needed.  I just talked.

Later she told me, much to my surprise, that a (imagined) little girl hid behind my chair while we were in session, a split off, very separate, part of her.  Her terror and her trauma were personified by this mute child. This was my first highly dissociated client. But I did not know it at the time.  I didn’t know it for a long, long time.

Frances came to me in the early 80’s after I had attended an inspiring conference in Boston on the psychology of women.  The counseling center where I was on staff paid for a colleague and I to attend the conference at Harvard University.  One paper on sexual violence against women stood out among the many wonderful talks.  Judith Lewis Herman asked of the 900 (mostly) female psychotherapists how many had been mugged.  People raised their hands.  She went on to say that she could not ask for a show of hands of victims of sexual violence, rape or childhood sexual abuse,  as victims of these crimes are stigmatized.    The victim is the one left with the shame, silenced by the shame, damaged by the shame.  The perpetrator is mostly unknown, mostly unmarked. 

This paper turned out to be life changing for me; it was a key moment in shaping my identity as a psychotherapist.   My colleague, soon to become my friend, and I stood together during the break sipping tea, munching croissants and sharing bits and pieces of our life story, intimate pieces.  We were moved by both the paper and by Judith Herman’s tribute to her recently deceased mother who had been scheduled to deliver a paper at this conference as well.  At the break there were dozens of women flocking to the pay phones to call their mothers.  Women and mothers were being honored and the wounds of women were being witnessed in an open and even welcoming way. 

Both the women’s movement of the 70’s and the anti-war movement of that time had both fueled the interest and investigation of the twin issues of  the trauma effects of war and violence against women.  Judy Herman inspired me to carry the torch and the impassioned message to the mental health staff with whom I worked, the town in which I lived, the people that I knew.  Eventually I taught this material to graduate students but it started with my presentation at a staff meeting.

At the time I was a member of a mostly male staff at a pastoral counseling center.  This material was new and perhaps not particularly welcome to that group.  I brought my experience of the conference and Herman’s meticulously researched paper to the staff.  I was excited about what I had learned and somehow empowered by it as well.  I was taken aback when I got a lot of questions like: “Is this really true, that one in three women have been sexually abused by the age of 18?”   In the early 1980’s the notion that large numbers of women and children might be victims of sexual trauma and suffering from its aftereffects was not quite mainstream.  I distinctly remember one staff member asking me, chuckling, “how could one actually rape one’s wife?”  In other words is it rape if you are married?  I could linger on my outrage, but I won’t. 

The upshot of that presentation was that I became known as the resident “expert” on sexual abuse. 

Frances was referred to me shortly after that staff meeting.  A staff member who was seeing a couple learned in the first session or two that Frances had a history of sexual abuse.  He referred her to me.  “We have someone who is an expert on sexual abuse,” he told Frances. I knew the truth: no one on that all male staff wanted to touch this.  But I was new at the counseling center and I was game.  

It actually turned out to be very challenging.  The marriage that had brought her into the treatment, failed rather quickly.  We didn’t talk much about the marriage or the sexual abuse history.  We didn’t talk about much.  She barely spoke to me for 2 years.  Frances was young,  mid-20’s, tall, thin, and sad. Very sad.  She held herself  tightly, rigid with suspicion. When she did speak her sentences were short and typically unrevealing.  The “shame” that Herman spoke of seemed to leak from her pores.  She looked terrified.

Frances cancelled appointments more often than not.  Maybe I wasn’t busy at the time, and I certainly was interested in her and drawn to her sadness, her silent suffering, so I called her each time she cancelled.  She always showed up the following week.   She asked me, many years later: “Why did you always call me?”  Truthfully, I have no idea.

But pursue her I did.  I think back on that time and wonder how I managed all that silence.  I did strive to “know” her in some way even though she was too frightened to tell me who she was.  I knew enough not to let the silence stretch on.  So I talked about fear, her fear,  about safety and how unsafe it might have felt to her to be in the office with me.  Her gaze was either downcast or wide-eyed. 

Today I would know so much better how to do this then I did then.  Today I would  consult what was going on in my own mind and body for clues for how she was feeling: where was I tense?  did I notice pain or strong sensation one place or another within me?  did my breath quicken? was how unmoored I felt in that situation a reflection of how lost she felt? how was my posture mirroring hers and what did it tell me about what was going on?

In retrospect I think she probably was as bewildered as I, as to how to proceed.  Today I know that there is an invisible force that we call “resonance” that tells us a lot about our companions if we “listen” in the right way. There is resonance between us all.  Today therapists are more familiar with concepts having to do with interpersonal energy and silent communication, right brain to right brain.  Affect is communicated silently.  We just have to listen differently.  But, alas, all that knowledge was decades away, way into my future as a clinician.

At that time my chatter was more about not leaving her alone with her fear and dread.  The content was less important than that there were words of some sort.  I was groping for a connection, some thread, a bridge that we could construct together.  She never became much of a talker, always dropping in and out of therapy at critical moments in the treatment.  But we did construct a bumpy bridge over time and most importantly, the little girl, who I did not initially know  was there,  listened in to what we were doing together and grew.

Frances started and finished college, the first in her very large family to do this.  She became a professional and a single parent.  She did a good job of raising her son, alone, and providing for herself.  She bought and restored a house.   She survived a severe illness, and a near fatal car accident and rehabbed herself from both.

In the years to come I was to treat several more severely traumatized women who had many sequestered part-selves.  Frances and two others remained in treatment for decades.

Like most therapists of that time I did not  recognize the phenomena of multiple self states until it screamed in my face.  I was among the throngs of therapists who believed that Multiple Personality Disorder, as it was then known, was a rare condition.  I remember saying to a client who was a criminal lawyer and felt that many of her imprisoned clients had “multiple personalities,” that that was “highly unlikely, it’s a very rare condition” I stated with authority.  Ha!

Today the idea of multiple selves does not make us uneasy.  This was not always so. When I was starting out in my work with individuals with much early trauma in their life histories, over 30 years ago, the concept of multiple self-states was not part of common/shared wisdom.  Today we have a Pixar movie about animated self- states in the head of a joyous 11 year girl, Inside Out. 

Today we easily grasp the notion that there is the work-self, the part that shows up at home, distinct from the part that shows up at parties, or sporting events, or with intimate friends.  My daughter, like many of us, has three different voice mail messages: work, home, cell phone.  At work the pitch of her voice is low, she is professional, deliberate and someone to be taken seriously.  On her cell she is casual, the pitch a little higher.  The home voice mail  sounds like a different person altogether: peppy, cheerful, the pitch at least an octave above the work email.  That woman/girl is young, energetic and fun.  This is both different and not different from having multiple selves.  Each voice mail message conveys the circumstance and the  state of being that she occupies in each setting. My daughter has easy access to each “self -state.”  She remembers what is going on at work when she is at home, and if she has to take a work call at home, amidst preparing dinner and directing the children, she can do so fairly easily. There is fluidity. 

The difference between individuals who have sharply segregated “selves” that cause the kind of serious problems that lead them into therapy and more functional individuals is that the former do not have easy access to all the states that my daughter, described above, has.  Some “parts” go to work, some parts parent, many parts hold the trauma memories, not all the parts go to therapy, at least initially.  Frequently the parts do not know each other, or only some do; communication across the system is typically poor.

In Dissociative Identity Disorder (the new designation for Multiple Personality Disorder) parts of experience, the really awful bits, are sequestered in sections of the overall personality so that literally the left hand doesn’t know what the right hand knows.  Tommy the rock opera, written in the 60’s captures some of what this looks like.  Tommy, was a Rock album by The Who, a movie, and a musical on Broadway.  Tommy is a traumatized little boy who becomes deaf,  mute, blind and a wizard at “pinball”.   A boy who cannot see becomes a champ at a sport where participants generally have keen sight. 

Tommy was born with all his senses intact.   When quite small he witnesses the  murder of his father at the hands of his mother’s lover.  The boy is the only witness.  The mother sings to her son:

You didn't hear it
You didn't see it.
You won't say nothing to no one
ever in your life….

You won't say nothing to no one
Never tell a soul
What you know is the Truth.

Little Tommy manages to go blind, deaf, and mute to conform with the pleas and commands of his parents,   But he holds to the truth deep within.  It turns out that there is a great way to do this: its call “dissociation.”

Sickness will surely take the mind
Where minds can't usually go.
Come on the amazing journey
And learn all you should know.

And I did, I went on the journey and it changed me.

Posted this awhile ago on Huffington. About my father and a lost history of trauma.

http://www.huffingtonpost.com/may-benatar-phd-lcsw/disappeared-david-trauma-_b_8239002.html

NEW POST ON THE HUFFINGTON POST

Thanks for viewing and commenting.

    http://www.huffingtonpost.com/may-benatar-phd-lcsw/a-reagantype-marriage_b_9597078.html

YOUR CHILDREN ARE NOT YOUR CHILDREN

Your children are not your children.
They are the sons and daughters of Life's longing for itself.
They come through you but not from you,
And though they are with you yet they belong not to you.

You may give them your love but not your thoughts,
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams.
You may strive to be like them,
but seek not to make them like you.
For life goes not backward nor tarries with yesterday.

Some of you may know these words from a poem by Kahlil Gibran.  Some of you may know the lyrics from its adaptation by “Sweet Honey in the Rock,”  an all-woman, African-American, a cappella, gospel-inflected, ensemble.  Their music was featured in our home (on our record player!)  when my children were growing up in the early 80’s.  They loved the music.  So did I.

The lyrics of this particular song… not so much.

If my children are not my children, then whose are they?  And what do you mean they are not mine?!   Or so it went.

When I first became a parent I found it difficult to let go of my own aims, my own rhythms.  I felt the loss of my unencumbered life, or at least mostly unencumbered life.  The physical demands and the confinement were challenging.   For me, it was a bumpy process becoming a parent, hard work,  and to be presented with the idea that they were not truly mine, I was merely a mid-wife, was not welcome.

 I’ve been thinking about this notion of “possession” of children since I read  Andrew Solomon’s wonderful, door stop-erish tome: Far From the Tree. 

This is a  beautifully written,  compassionate,  tender and nuanced examination of the implications for parental identity  when  offspring are starkly different from their parents, when parents cannot find their own image or influence in the eyes, the bodies, and the values of their children.  Parents of autistic children, transgendered children, handicapped children, criminal children, schizophrenic children, dwarfs and deaf children as well as many others, were interviewed (over 300 families).   Solomon  thinks deeply about their trials and their triumphs.   There are those who reject their “variant” children and those who embrace them happily.
                 I think Solomon would have us think a little harder about the illusion of our children being “our children” in the more ordinary situation. The first sentence of Solomon’s book reads: “There is no such thing as reproduction.”  We call it reproducing—having children.  We search our infant’s faces and cannot resist comparing them to our own, our partner’s or at least great-aunt Bertha’s.  And their sweet temperament must be a reflection of our own.  Their colicky nature, surely from the other side.   Are we reproducing or are we mostly ­­producing? a grand accomplishment  in and of itself.  Maybe in all cases children are not merely a “chip off the old block,” but a completely new, unique, beloved “chip”

As I reflect on the obsessive involvement with my own children in the early years and how alien the idea of their not being “mine,” I see how adaptive it was at the time, to see them as extensions of myself, a more beautiful, perfected, unblemished extension at that.   And I think in the early years, it was highly adaptive to cling to this illusion.  Loving my children was a form of “self-love.”  Not the malignant kind, but the benign and necessary kind. 

Generally we think of  “parental narcissism” (in so far as we think of this at all) as a toxic quality.  We picture characters like the mother in the movie “Ordinary People” (played so expertly by Mary Tyler Moore)  who do not truly see their children as real people but only as characters in a play of  their own design, there to serve the parental hero and heroine’s needs.  There is a ruthlessness about them.

Parental narcissism is natural, ubiquitous and serves a serious purpose.  Narcissism is generally associated with selfishness and associated with a disorder. But there is pathological narcissism and appropriate or healthy narcissism.   Without some degree of self-love we are in trouble.  It is a developmentally necessary quality, both to love yourself and to enlarge the circle of self - love to include your children and others.  Insofar as we see ourselves in their eyes or in their sweetness, their scent we are in love with our off spring.  It is a serious problem when this fails to happen.   

Things go awry when the individuality, the uniqueness of the child is denied in the service of meeting the needs of the parent.  That’s the kind of narcissism we generally think of when speaking of parental narcissism.  The miracle is balancing the enormous gratification of seeing ourselves in our beloved children and restraining ourselves. When I speak of the benign sort of parental narcissism,  I have in mind something less ruthless, more loving, and flexible.  It has lots of room for empathy. 

 As the children grow the illusion of  “they are us”  needs to fade.  If we don’t begin to see them as who they are and not a deep reflection of ourselves we start to do them a disservice.  They may have preferences that are quite alien.

            I think of the child who comes back from camp and wants to be a vegetarian, or now needs Kosher meals to be prepared by their secular parents.  I think of children who choose a different religion, perhaps a fundamentalist religion to follow and observe.  The son of left wing parents who wants to become a marine,  or the daughter of right wing parents who comes out as a lesbian and lobbies for marriage equality.  These are challenges for parents,  challenges that need to be negotiated with a relinquishment of the earlier narcissistic  investment.   We produce,  not reproduce.

           

You may give them your love but not your thoughts,
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams

I'M SORRY

Many years ago I viewed a documentary, on a PBS channel that addressed the effects of

the Holocaust  on the second generation, children born of concentration camp survivors.    Much has been written and studied on the effects on the second and even third generation of survivors of the Holocaust.  The secondary wounding of  offspring of trauma survivors, whether they be survivors of war, concentration camp or childhood trauma are well documented.

It must have been in the mid 80’s that I watched a PBS documentary on the relationship beween adult children and their parents, Holocaust survivors all.   It was fascinating and heartbreaking.  Engraved on my memory over the intervening decades is one scene in particular.

In the film, adult “children” were discussing with their parents what it had been like for them to be shut out of their parents’ experience and/or to be victimized secondarily by it.  There were poignant dialogues between the generations.  Among other things, the younger adults had felt that their own suffering, their own experiences of pain were never quite as valid, as the horrors and loss that their parents had suffered.  Some felt it fell to them to redeem, to heal their parents.  

The scene that has stayed with me was a unique one.  One daughter, tearfully addressed her mother with her suffering.  The mother, who had been a child during the Holocaust, and clearly unaware of the effect her experiences had had on her daughter, was at a loss, initially, as to how to respond. Finally she said “I’m sorry, I’m really, really sorry.”   More than any other words intoned in those dialogues, those words held the most power.

Viewers witnessed the potential for repair in that very moment.

I’ve held on to this scene in the intervening decades and even shared the story with patients who clearly were in need of having this kind of validation in their own lives.  It is both a phrase that I have not heard enough in my own life, and one that I have employed far too sparingly myself.  Two words that we all long for.

We read and hear a lot about the importance of the balm of forgiveness, how it heals the giver and as well as the given too.  But I think we don’t think enough about the power of of  asking for forgiveness, to knit together what feels irretrievably broken. Forgiveness is a hard nut to crack—that is, offering forgiveness that isn’t a thinly disguised form of denial.   But we can all apologize for wrongs we have committed.   An attuned apology is not  necessarily asking for forgiveness but rather an expression of empathy, compassion, “heart feeling” for the person we have wronged in some way, or at least they have perceived a wrong and have been wounded.

It happens  sometimes in my clinical practice that an angry client confronts me with some way in which I have hurt them.  Maybe I have been too blunt, insensitive, or just plain wrong. My timing has been lousy.  Sometimes I’m not guilty, but more often than not I am.  At least a little.  After years of trying to explain, clarify, interpret, really to defend myself,  I have come to realize that it is all a waste of time.  A simple, but “attuned” apology is what is called for here.  Whatever my motive or the context for my misstep, I have hurt someone.

This is sometimes difficult in the midst of an attack—an angry, no holds bar, maybe even abusive client is not someone easy to apologize to.  But there is always time for the interpretation, the exploration, and the meaning of the attack.  In the moment “I’m sorry” may be the only way to get back on track.

Recently a client shared with me what was a pivotal moment for him.  He was berating me for a misstep, which he had done before, and hinted strongly that he was seriously considering leaving therapy.  I asked: do you want to repair the rent in our relationship?  Stopped in his tracks by the question he had to admit that that was indeed a novel idea, “repair.”  He had never witnessed it within his own family.  Either a violent argument was forgotten, denied, disowned or it “broke” the relationship forever.  The notion of repair was alien.  Eventually he replied in the affirmative, yes he wanted to see if this relationship could be fixed.  I offered an apology and he was able to re-join  the collaboration and let go of the all too familiar role of wounded adversary.

Dan Siegel, the interpersonal neurobiology psychiatrist, clinician, and researcher makes the important point in a recent publication: the ability to initiate repair requires a certain humility, an acceptance that we are inperfect. 

It is part of being human to contribute to disruptions in connections with others.  Yet processes like shame can keep us from freely acknowledging our role and making a repair to reconnect with the other person.  These impediments to repair can severely constrain the health of a relationship (The Pocket Guide to Interpersonal Neurobiology).”

In other words my general tendency to defend my actions was probably rooted in an expectation of myself that I would never wrong a patient.  “Mistakes might be made,” but never by me!

I will let Rumi, the 13^th Century Sufi poet summarize for me:

Out beyond ideas

of wrongdoing and rightdoing

There is a field.

I’ll meet you there.

MUSINGS OF THE LONG DISTANCE THERAPIST

  

In a few months, I will turn 70.  It will be over 40 years that I have been in clinical practice.

That sentence is actually a pretty shocking one to compose.  It hardly seems possible.  Forty years is a very long time.  So many of my colleagues from the early days no longer practice psychotherapy.  They left the field for various reasons, some very early on.  Being a clinical social worker, or a family and marriage therapist doesn’t pay very well.  The working conditions are not always pleasant, clients are disappointed, they are angry, they lash out, they fire you without notice and sometimes even explanation.  You are sitting still much of the day absorbing the pain, the shame, the trauma, the fury of your clients.  If you work in an agency you can be subject to crushing piles of paperwork and a remarkable lack of respect.

And then there is the weight of responsibility, or felt responsibility, for the well-being of others.  There is always the prospect that you will fail.  There is the dire prospect that the client will harm themselves or others. 

But like the song says, “I’m still here.” 

Quite a surprise.  Starting out I thought I would never make it, that my high level of anxiety would kill me.  But as I client once scolded me, I am persistent, “like a dog with a bone” is the way she put it: not pretty, but apt.

  

I’ve never been much good at puzzles, either crossword puzzles, picture puzzles, or Sudoku.   You can always have the puzzle page of the New York Times out of my newspaper anytime you want. 

But the puzzle of a personality I find intensely engaging.  Without exception every new client is a new puzzle, an original.  Why this symptom and not that?  What happened? Why (seek treatment) now and not before. Why did he survive and she didn’t?  Why did this sibling make it through an abusive childhood and the other one, not so much?

And the key to the puzzle is not written in a book anywhere, there is no standard protocol, the way I work anyhow.  It’s always a new task to figure it out, how to treat this person.  What’s going to work?

Then there is my fascination with the story, the narrative of a life. I spent a lot of time as a child with the “orange biographies,” biographies of “great Americans.”  Our small town library had what seemed liked hundreds of them.  I took a stack out every two weeks.  I consumed everything thing from the story of Davy Crockett, frontiersman, to Florence Nightingale, Mary Todd Lincoln, Jane Addams, George Washington.  So was it the history that I loved so much, or the prospect of greatness?   Perhaps if I read enough of them, maybe I could join their ranks?   No, I think it was the story of lives, lived.  And I’m still here, with those stories.

It is a privileged perch, the perch of the therapist.  One gets to witness all the lives not lived: what it’s like being related to the mob, or to be the neglected child of great wealth.    I get a taste of growing up in Lake Woebegone, Garrison Keillor’s fictitious small Midwestern town, without having ever been to Minnesota.  I get to talk to the voices that populate the inner world of seriously traumatized individuals.

The “privileged perch” can be hazardous.  There is no doubt that if you work with trauma, as so many of us do, that your world view is darkened thereby.   The tales of ritualistic abuse and sadistic cruelty toward children are often hard for people to believe, even therapists.  A supervisee, new to the treatment of the long term effects of extreme trauma, once asked if I believed the tales of multiple rapes and torture that her patients and mine recalled.    I really cannot, of course, offer a definitive answer in any particular case. No one can. But we did live through a century when state sanctioned murder and torture and rape were applied on a mass scale, so why not? 

Here are a few things I have learned from being a therapist:

1.       Motivation counts more than the extent of pathology. People who desperately want to get better, generally do.

2.      Safety counts more than anything.  Anything one can do to help a client feel safe with you and in your office facilitates the healing.  Maybe it is the healing.

3.      Chemistry counts. Who you are is what counts:  “The person of the therapist is the converting catalyst, not his order or credo…not his exquisitely chosen words or denominational silences” (from A General Theory of Love, Lewis, T.,Amini, F., Lannon, R., p.187).

4.       Spirit often arises from the extremities of suffering.  It’s almost uncanny how those who have survived early and extreme trauma and make it into my office, arrive with rather robust spiritual lives.  Not conventionally religious, they are still believers in the transcendent and credit those experiences with their survival.  These patients have taught me a lot about resilienc, spirit and spirituality.

  

Over 40 years of almost continuous practice: it is hard to really comprehend that amount of time. I do comprehend, though, what a blessing it is to have been part of a profession that has brought richness and meaning to so many days of my life.  I am grateful.

New TED Talk blog posting on the Huffington Post.

Dear Readers,

The Huffington Post asked me to write a response to a wonderful Ted Talk, as part of the Ted Radio Hour.
Maybe some of you are familiar with this NPR program?
The talk is wonderful.  By Candy Chang, entitled "Before I Die."
And they were kind enough to select my blog (among others) to post alongside the video, this on their
TED page.  See it at   http://www.huffingtonpost.com/may-benatar-phd-lcsw/before-i-die_b_3468120.html
If you feel like commenting on the Huff Po page, it makes me look good.

Thanks!

Rehearsing for Life and Death

REHEARSING FOR LIFE AND DEATH

A little boy of my acquaintance is worried about death and graveyards and ghosts.  I have been thinking of comforting ways to talk to him about this—something that might be accessible to a 6 year old.  In the midst of my musings I awoke to the fact that I am just as afraid as he, although ghosts and graveyards don’t really bother me so much.   It seems that the predations and losses of aging are my own version of his preoccupation.  The inevitable debility in the body, losing loved ones, mourning recent losses,  these are my ghosts.

I think after a year and a half of working at a cancer support and wellness center in the DC metro area, I am just coming to understand what drew me to this work.  I volunteer once a week to lead a mindfulness meditation group.  I have not been officially trained to do so.  This is in itself remarkable.  I am, however, a qualified, trained, and experienced therapist and a fairly long time practitioner of meditation myself, but my teaching experience is not particularly in this genre.  In the group we mix it up with other practices and I am always drawing on my skills and various tools acquired as a therapist, to deepen and broaden the experience for my very enthusiastic group of meditators.    Remarkably, the changes in those individuals who come consistently and even attempt to practice at home are discernible to themselves and to me.
The members of the group declaim rather loudly and proudly about the benefits and positive energy of the group—they testify to and regularly recruit new members.  But I am quite aware that my benefit is at least as great as theirs.  It is the high point in my week.  Really.

There is the pleasure in doing something that is popular, useful, and positive.  But beyond that, I think I benefit greatly from my relationship with members of the group and with the group as a whole
: their optimism, their strength, their ability to grow in the face of terrifying, often painful, and always life threatening conditions. 

Many are dealing with the long term effects of treatment, more than the threat to their lives.  Surgery, chemotherapy, and radiation leave a variety of “gifts” behind.  The hair grows back, but the neuropathy in hands and feet does not necessarily abate.  “Chemo brain” may recede, but memory may never be quite the same for some.  Unanticipated pain may linger for quite some time after radiation.  Anxiety may take up permanent residence, and thin places in the fabric of family may become deep fissures.

I get a front row seat on how individuals are dealing with these challenges to their bodily integrity and mortality.   Mostly what I see are courage, dignity, and grace under fire.  Of course it’s only an hour a week and a self selected group of individuals who are well enough to sit and listen to the sound of my voice directing them to more peaceful places inside of themselves.  And I don’t observe the moments of sheer terror and rage that walk beside them as well.  But these glimpses of resilience in the woman who dons a stylish chapeau to cover her sparse hair, or manages to look fetching in her outfit despite the loss of 25 pounds or so, enrich my spirit.  The man who teaches himself and practices piano to deal with his overwhelming anxiety and depression and the generous cordiality and even gratitude of those who face the final stages of their disease, inspire and soothe me.

This opportunity to bring comforting practices and to learn from my meditators represents for me a kind of rehearsal for what is inevitable in all of our lives.  Unless we die suddenly, we do need preparation for the last chapter and the loss of those close to us.  There are few models available, for most of death and dying are hidden.  We cannot model ourselves on the brave and the resilient if we don’t know them, if we don’t see them.    They are hidden in nursing homes, hospitals, or hidden away at home.  They are for the most part unidentified.   I have the unusual privilege of meeting, working with and learning from many.

I learned to teach graduate students, something I was also terrified of, by “channeling” one of my most admired teachers and then pretending I was him.  I faked it until I made it. 

Sounds like a plan.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ME AND NEWTOWN

It was probably 1965 when I did my co op job at  Fairfield Hills State Hospital in Newtown, Connecticut.  This was a huge state hospital campus housing thousands of inpatients from all over the state in need of (mostly) long term custodial psychiatric care.  Although this was decades ago, many of my memories of this time are fresh and crisp.  It was one of a few experiences that shaped my interest in becoming a mental health professional.

The setting, a large institution in rural Newtown, Ct.,  was woefully isolated for two young women in their early 20 's dispatched by Antioch college to fulfill their co-op job requirement. We hung out with some other co-op students from Boston and two male psychologists doing their internship at the hospital.   Gimlets at weeks end with the psychologists were all that was available for “partying.”

There was basically no town in Newtown, as I remember it.   We had to catch a ride into NYC if we expected much fun. 

My memories of the facility where we worked, me as an occupational therapy assistant, my friend J. as an art therapist, are quite positivE, however.  The woman under whom I worked was a consummate professional.  She was highly skilled at creating a program for people who were severely mentally ill and compassionate in her attunement to each individual.  I learned a lot from her.   When I wasn’t working directly with patients, she sent me down to read case records.

On one of those occasions I accidentally discovered that one of the in-patients with whom we worked had come to the hospital  voluntarily, for a short period, had somehow gotten lost in the system and was now a long term resident.  Tommy was not psychotic,  he had come to the hospital for the treatment of depression. Over time he had come to look like he belonged there and did not have anyone to advocate for him. He was heavily medicated, and a physical impairment made him look much sicker than he was.

When I shared this with Madelyn, my boss, she got busy, had him re-evaluated and in short order, "sprung" from the hospital.   Tommy was the poster boy, you might say, for “institutionalization.”  The system had swallowed him whole. It was only a lucky accident that freed him.

Madelyn was not alone among the staff of competent and compassionate employees.  This was a good facility.  Some people got stuck, but most were there because they needed the shelter and the supervision.  Many had nowhere to go.  Larry was an example.  He was in the end stages of Huntington's disease,  a neurodegenerative genetic disorder (the disease that Woody Gutherie succumbed to)  with no cure.     The end stage was often characterized by psychosis.

Larry was a very sweet, bright guy.   He had been a working jazz musician in his prime.  Now he had a hard time walking, controlling the jerky movements characteristic of Huntington’s disease.  And he had psychotic episodes.  He needed the  care that the hospital offered and had few or no other options.  Madelyn was very fond of him and took good care of him.

Patients like Tommy inspired the civil rights activists who felt that the mentally ill were unjustly stripped of their legal rights and were often incarcerated against their will.  They became “institutionalized” and were unable to care for themselves out of the hospital only because they had been socialized to the hospital setting.   In Tommy’s case all of this was true.

But they forgot about Larry, and so many other patients who derived protection from the system, not exploitation and abuse. Sadly, Larry needed the care and protection that the hospital provided.

How strange it is for me to meld my memories of Newtown with current events, in which how to care for the mentally ill is heartbreaking front page news.  My  memory is also vivid for the sweeping policy changes and paradigm shifting of the late 60’s and 70’s that emptied the state hospitals, filled the streets with the homeless mentally ill, and made it next to impossible to care for the seriously mentally ill in any viable custodial arrangements. 

In the name of freedom,  we forsook the mentally ill decades and decades ago.  Instead of re-thinking the system, we jettisoned it, de-funded it, and provided nothing to take its place. 

I join my voice to all the others calling for a humane reconsideration of our responsibilities to the seriously mentally ill.

What Good Can It (Psychotherapy) do?

What good can it ( psychotherapy) do?

The  question above is one that I encounter frequently in one form or another from friends, potential clients, close relatives.  It takes various forms:

1. What can they tell me that I haven’t already thought of myself?
2. Life will take its course no matter who I talk to.  My partner will die and I will be alone.
3. I’m going to die anyhow.
4. Talking won’t bring her/him back.
5. I’ll still have cancer/multiple sclerosis/end stage heart disease.
6. There really is no way out of my marital/familial/work dilemma.
7. My depression is a result of a chemical imbalance.

I’m frequently not quick enough on my feet to respond thoughtfully, so I’d like to take a moment to do so now.

Therapy, at least the kind that I know about, is not chiefly about finding solutions, i.e., problem solving.  Intelligent people are generally quite aware of a range of solutions to their problems.   They just can’t act on them.  They are frozen.

They  think that no potential solutions are really applicable to their situation or relevant or available to them.  Or they feel, and perhaps this is the  most frequent, that in their particular case there are no real solutions.   Its almost reflexive for the listener, the relative, the loved one, the good friend, the clergy person, even some therapists to offer some thoughts as to possible solutions.  Inevitably they fail.  Its not about that.

Within most adult folks there is an inner wisdom that would offer great assist in resolving the impasses of our life. Therapy is about accessing our inner, innate wisdom, not replacing it with someone else’s.  I can think of many instances where I felt that there were no solutions.  I was trapped.  In retrospect I knew the solutions and just found them totally unpalatable.  I could not end that destructive friendship, it was just too important to me.  I could not resolve a domestic or an economic problem, I just wasn’t strong enough.

So what are the elements of psychotherapy that  enable that inner compass.

1. the magic of relationship.  When researchers have tried to isolate the “active” ingredient in successful psychotherapies, across many theoretical approaches (CBT, psychoanalysis, mind/body  approaches)  they frequently come up with the same answer:  “it’s the relationship, stupid,” the connection between therapist and patient is the key remedial. 

Neuroscientists have a more exact way of stating this, it’s about “limbic (a key brain structure) resonance.”   Simply stated,  therapy is not so much about the rational, linear, thinking mind.  It’s more like music.  In the best situation the therapist hears the particular melodic essence of the individual, playing softly in the background and is able to tune in and hum along, maybe even in harmony.  Just this tuning in is deeply healing.  How many people in your life have actually heard your “melodic essence”?  Do you think even you have heard it?

2.  A therapist listens differently than other people. I heard a story once of a psychotherapist describe his occupation, at a cocktail party, as one of  listening  “I listen for a living.”

A therapist’s training and experience sharpen and educate their musical ear.  It has been called “listening with the third ear, (Theodore Reik)” among other things.   When things go well, a good therapist hears what others do not, even the speaker.

A therapist may hear anger where others only hear hopelessness, fear where others hear anger, shame where others hear belligerence.   Truly thrilling for both the patient and the therapist is the moment when a door opens and the narrator gets a slightly different perspective, a different way of hearing their own feelings/problems.   “Maybe its not my inadequacy, maybe I am feeling truly alone in this intimate relationship.”  “Perhaps my adversary doesn’t hate me, perhaps they are deeply ashamed of their failures in life and feel humiliated.”  And most powerfully, “maybe there is meaning embedded in my confusion and in my unremitting pain.”   Meaning can set one free.

Certainly there is much more to be said on this subject.  But I will pause here and invite readers, both those who have experienced therapy and those contemplating dipping a toe in, to share their thoughts.

Happy New Year to all!!

MENTAL HEALTH NOTES: Personal Transformation and Wrestling with the Dark Side

After writing my last post (www.huffingtonpost.com/may-benatar-phd-lcsw/neuroplasticity_b_1729070.html)  and reviewing the comments I received, it occurred to me that I hadn’t told Stuart Smiley’s entire story.  Stuart’s  dark side is an important part of his story, indeed an important part of all of our stories.  I did mention that he was a mess.

I’m going to switch characters here.  The story of  Jacob’s struggle with an angel in (Genesis 32:24-30), provides a more sober and profound metaphor for the following exploration.  Personal transformation is not just about affirming the positive, it’s about investigating the negative as well; its about struggle.   The task of psychotherapy,  at its most profound and meaningful level is all about transformation, inhabiting more fully who we are.  And that is Jacob’s story as well.

In Genesis (32:24-30), the first book of the Bible, the first book of the Jewish Torah, Jacob leaves home to meet his nemesis and twin brother Esau.  Esau  wants to kill him.  Esau is angry with Jacob for having stolen his birthright, his father’s blessing, many year’s before.

While on this journey to meet Esau, Jacob has the famous encounter with a mysterious entity.   It is an encounter marked by struggle and suffering.  They wrestle throughout the night.  They wrestle  to a draw and  Jacob is released by the angel who insists Jacob take a new name: Israel.

Interpreters of the Bible story have various ways of interpreting this narrative.  Who is the angel?    Is it G-d?  Is it Jacob’s own fear of the coming encounter with Esau?  Or is it Jacob's own dark side.   And it appears he had a very prominent dark side.  He manipulated his father and stole from his brother for one thing.   The latter explanation, the most psychological one, of course, appeals to me.  This interpretation has Jacob struggling with his own flawed character.   In the process he is both wounded and reborn.  He gets a new name,  he becomes more of who he really is.  And this is the nature of transformation.

What a wonderful paradigm for the best outcomes of psychotherapy.  And I emphasize best, over common.  While the power of positive thinking is an important and real possibility for us all in recasting our fates—the need to embrace the shadow,  those elements of our personality, our souls of which we are least proud, is a  necessary element of transformation.

Trudy wanted to retire and to begin working seriously at her bucket list:  to travel to Nepal,  to write more poems,  to read and garden to her heart’s delight.  She knew it was time.  She felt really burnt by her 40 years of work as an emergency room physician.  Nothing called to her any more about her profession.  The adrenaline generated by the high intensity work had in the end depleted her.  It was definitely time to move on.

Strangely she found that she couldn’t.  She was dogged by guilt, haunted by bad dreams.  And that was when she could fall asleep.  Insomnia and an exacerbation of her long dormant ulcer had her prescribing medications for herself.  Finally, feeling it was a last resort, she went into therapy.

It took about 6 months of pretty intensive work with her therapist to uncover the source of the guilt.

Trudy came from a high achieving, well to do, but essentially emotionally disconnected family.  The three children  had had to fend for themselves as their parents pursued their
own interests, their travel, and their careers.   Despite this the two oldest children adapted well.  They performed well in school, had many friends, and took care of each other. 
  
The youngest did less well.  He struggled in school,  seemed to be the odd man out socially, frequently got into trouble with the authorities, and was finally expelled from school.  As the oldest child, Trudy knew what was expected of her to help:  she needed to take care of  her little brother.  But she didn’t want to.  For one thing she didn’t know what to do about him,  although 5 years older, she was a kid herself.   For another she was successful both socially and academically and had no real interest in parenting. 
She had made half hearted tries but she resented anything she was asked to do for him.  And plenty was asked.  The parents were preoccupied and clueless themselves as to how to help their son.

The baby brother never did pull himself out of his troubles.  As an adolescent he got into harder and harder drugs and very tragically died of an overdose at age 20.

What Trudy discovered in psychotherapy was that she had never forgiven herself for abandoning her brother.  And she really had to acknowledge that it was an abandonment.  True, she was a child herself and did not have the knowledge or skills to help her brother,  but on a deeper level she just didn’t want to.  She didn’t much like him or sympathize with him—he was always a trouble maker and a drain on the very slim emotional  resources of the family.  The stain on her soul was not what she did or didn’t do,  it was what she felt.  

What she had to wrestle with was her own nature, or what she thought was her nature.  She had not wanted to help her brother and he had died of neglect.

It took another 18 months at least for Trudy to come to terms with all of this.  Actually it probably will take many years beyond these months.  Trudy had to seriously consider that she had become an ER doctor because it was an arena in which she could save people. And that she did.  And now she couldn’t leave it, because to do so would expose the wound: her own self-loathing.

The struggle (in this case her work in therapy) left its mark on Trudy—the wound that had been  there but invisible became visible.  For a short time she needed anti-depressant medication,  later something to help her with her anxiety.  But in the end, she knew her own name.   She became more of who she was.   And eventually she retired.

Mental Health Notes: Stuart Smalley and Neuroplasticity

Stuart Smalley was a  character on Saturday Night Live played by Al Franken,  now a distinguished member of congress, then a distinguished comedian. In the  90’s he was a regular on Saturday Night Live.   Blonde and dimpled, somewhat effeminate, Stuart was an earnest simpleton, distinctly un-cool in his cardigan he was “a member of several 12 step programs, not a licensed therapist.”   Actually he was a mess.

One of his funnier bits was staring into a mirror and speaking aloud affirmations, to be repeated daily? “I am good enough, I am smart enough,  and doggone it  people like me.”  There was also: “I am an attractive person, I deserve my share of happiness, I deserve good things.”

The hilarious implication was of course how silly and self indulgent it was to think flattering yourself in front of a mirror really meant anything.

But you know what, it turns out that Stuart Smalley was on to something.

What we now know about neural functioning indicates pretty strongly that what we think can and does change our brain.   In the last twenty years there has been an explosion of new understanding in brain science.  There is more sophisticated, detail mapping of the brain and its functions and very importantly we have learned that the brain is malleable, not fixed as we once thought.  This is why a meditation practice, learning a language, and taking up a musical instrument can demonstrably change brain structure, even quite late in life.

What changes the brain, and/or the mind, changes the body, the immune system, blood pressure, cardiac function, stroke recovery and so much more.    Sophisticated methods of brain scanning have given us access to how all of this works.

The slogan is : what fires together, wires together.  As neurons fire (which is what happens with thought),  they connect to each other.  The more they fire, the stronger the wire.   If you practice weight lifting, or swimming, or piano, or French, you gain more facility, you get better and better—the neural connections grow stronger and stronger.  So if you think good thoughts, that might have an effect also, right?

I have just read the book Freedom from Pain: Discover Your Body’s Power to Overcome Physical Pain, by Peter Levine, Ph.D. and Maggie Phillips, Ph.D.  This book is chock full of exercises and regular practices, that can help people in acute or chronic pain, manage their pain.  Many of the exercises are based on Somatic Experiencing (SE), many on energy medicine.  Somatic Experiencing developed by Peter Levine, is a body awareness approach to treating trauma  http://www.traumahealing.com/ 
Pain is a form of trauma.

See previous posts on this site on the subject of SE: http://www.postsfromtheunconscious.blogspot.com/2012/06/ptsd-kills.html
http://www.postsfromtheunconscious.blogspot.com/2012/04/orange-biographies-healing-narrative.html

Pain management is a very challenging area of healthcare with pain conditions nearly epidemic.  Medication can be helpful, but sometimes falls far short of bringing comfort, and almost always has side effects that can be distressing.  So practices that depend only on our ability to focus attention have enormous potential benefit.   And no side effects.

I was somewhat amused to see that Stuart Smiley’s methodology was one of the practices recommended by Levine and Phillips.  Here is the scientific justification:

Neuroplasticity research has turned this theory (genetic determination)on its head and gives us an entirely new way to look at the impact of our thoughts and beliefs.We know that thoughts literally change brain chemistry.  Research indicates that the chemical composition of the body can change in relation to a specific thought within twenty seconds (Levine and Phillips )p. 112.
…Research indicates that the chemical composition of the body can change in relation to a specific thought within twenty seconds p. 11.

Neuroscience has caught up to Saturday Night Live!

Try it.  And if you need inspiration, consider where Stuart Smiley is today:  The United States Senate.

PTSD KILLS

I hope that cardiologists everywhere are paying attention to a startling finding  reported online in PloS One.  A review of over 20 observational studies of  cardiac patients found that 1 in 8 (12.5%)  heart attack victims, or patients with unstable angina  had diagnosable PTSD (post traumatic stress disorder).     That’s almost double the  (lifetime) rate for PTSD in the general population.   Even more alarmingly this subgroup had double the  mortality rate of those without  PTSD within 3 to  5 years.  In these studies PTSD is very strictly defined as meeting the criteria in the current Diagnostic Manual of mental disorders.  If post traumatic effects like depression are factored in, the rates would undoubtedly be higher.  These findings were broadcast on mainstream media as well.

The study of the effects of war trauma have also reached the headlines as  the rate of suicide among active duty  military personnel now surpasses  the rate of battlefield deaths. ( The New York Times,  6/8/12).  The rate is nearly one a day.

Think about that.   Young men and women serving in  combat zones are more at risk for killing themselves than they are for being killed by enemy combatants. The war moves inside and destroys from within, at a devastating rate.

Long before PTSD reached the headlines, long before the shock and carnage of 911 made knowledge of the sequelae of trauma practically mainstream,  mental health clinicians were reporting back from the front lines of the  child abuse wars that a goodly portion of adults who had suffered as children from sexual abuse, neglect, physical violence,  sex trafficking and child pornography suffered from chronic PTSD;  victims of domestic and sexual violence, ditto.   Suicide rates may not be as high, but soul deaths, certainly.

The articles that I read that  reviewed the heart attack studies, noted that psychotherapy and medications were the treatment of choice for cardiac patients demonstrating trauma symptomatology.

I would like to add that body based techniques such as Somatic Experiencing and Sensorimotor Psychotherapy, as well as EMDR, are  good choices in the treatment of  a trauma that is essentially body based.   A heart attack is an attack on the  heart.  It is a "mugging"  within the body that is life threatening, not unlike a near fatal automobile accident, a rape, surviving an airplane crash,  or other near death experience.

The principal behind these body based approaches is that trauma triggers biologically based mechanisms of defense: fight, flight, and freeze.  PTSD and other serious problems will follow when the tremendous reservoir of energy that is recruited when we are threatened and overwhelmed gets locked in the body and can not be discharged.  A heart attack victim doesn’t have a lot of ways to discharge the impulse to flee the “attack,” or unlock from the freeze induced by overwhelming terror (I’m going to die!”).  A child victim cannot fight the predator even though the impulse to do so might be very present.

These body based treatments, or more accurately sensory  based approaches, like Somatic Experiencing or  Sensorimotor Psychotherapy are designed to address and rebalance  the nervous system by addressing it directly and not by way of  the higher cognitive functions.

A heart attack victim coming for treatment for PTSD may be gently and progressively lead  through the body memories of what it was like to experience the crushing pain, the terror, the helplessness, the uncertainty, all this on  a sensory level.  Where is it stored in the body?  What happens when we pay attention to those sensations of the body?    Together patient and therapist track sensation, imagery, and maybe motor inclinations.  All of these activities in the interest of discharging  all that pent up energy.  The work is done from the grass roots, so to speak, from the bottom up.  Cognitive approaches might be aptly described as from the top down.

This method is direct, gentle and amazingly effective.  For more information see
www.traumahealing.com  and

www.sensorimotorpsychotherapy.org/

or write to me.

The Orange Biographies, The Healing Narrative, and Somatic Techniques

I was delighted to see in Sunday’s New York  Times that David Sedaris read the orange biographies as child.  I  believe I read them all—everything that the children’s library in Marblehead,  MA had to offer.  These were the stories of “great Americans.”   The list that I recall included Abraham Lincoln, Clara Barton, and Wyatt Earp.

Looking back I think that even in third grade I found the personal narrative captivating and inspiring.  If I was going to be a great American, these were the books to read.

I suppose I have given up my aspiration for greatness.  But I have not relinquished my passion for stories, the stories of a life.  This has sustained me over decades in the practice of psychotherapy.  My job is mostly about helping people tell their stories.  I wrote in a blog several months ago (May 16, 2011 http://www.huffingtonpost.com/may-benatar-phd-lcsw/personal-narrative-healing_b_862285.html) about the value of creating the coherent personal narrative and the role of the therapist in this creation, this construction.  Sometimes it’s like solving a thousand piece puzzle, the story is jumbled, chaotic, fragmented.  Sometimes it is like picking out threads from a weave tangled with other people’s version of our story—“Mom said I was this kind of a child/person.  Auntie M. thought I was better than that.”

Sometimes there are holes as big as a truck in the story of one’s life—the individual seemingly retaining only crumbs of a history.   Figuring out what one’s own story is, from one’s own perspective, is both challenging and fascinating. 

The enterprise of constructing a coherent narrative of one’s life is mostly a cognitive process.    With the support and guidance of a skilled, empathic and alert listener, i.e. the psychotherapist, we come to understand how we got where we are, what has motivated, shaped, and had meaning for us.  We get to claim our own experience, from the inside out.  This is powerfully healing all by itself.

I have recently been learning about another kind of narrative:  the narrative of the body or the “felt sense.”  There are two new-ish techniques in which therapist’s are being trained, adding to their store of tools.  These techniques go beyond the verbal, the cognitive, beyond the prefrontal cortex so to speak.  Developed to work with trauma, Somatic Experiencing (SE) and Sensorimotor Psychotherapy (SP) focus attention from the grass roots, so to speak: Pat Ogden (founder of the Sensorimotor Psychotherapy Institute) refers to this as moving from the bottom up, felt experience, versus working from the top down, a more cognitive process.  The basic assumption is that the human nervous system is not unlike other mammalian nervous systems which have a self correcting, self healing potential.  Peter Levine (the developer of SE) reports that wild animals face trauma every day, and seem to bounce back within minutes of surviving a life threatening experience.  Trauma does not de-rail them.  There is no PTSD in the wild.

These new technologies which are being learned and mastered by practitioners around the world, tune in to a very different story:  the story stored in our body, in our “felt sense.”  Interestingly the stories that have been lost to the cognitive narrative, may be stored in the body and be accessible if one pays a certain kind of attention.  The body may have a very different story than the “remembered” story.

Next time you have a back ache, a bellyache, an attack of anxiety:  tune in for a few minutes, place your attention on the sensation and track it with your awareness.  Watch what happens: does it change?  Does it move?  Does it yield any information, image, anything? Does tuning in make you want to move or gesture in a certain way?

 Doing this will give you a taste of what these new techniques are like. 

For more information see www.traumahealing.com and/or www.sensorimotorpsychotherapy.org

THE MIRACLE OF ADAPTATION AND MR. WHITE EGRET

I was on a walk the other day.  The sun was out after many days of rain.  The creek along which I walk so often had become almost a river.  For the very first time, I noticed a white egret standing motionless  by a man-made waterfall on the creek.  The elegant bird looked as if she were trying to figure out how to navigate the cascade.  The creek had been but a trickle all summer.  But this fall had been unusually wet and stormy.  And the water was high and fast.

Strangely the bird was still there in the same spot, standing like a statue, unchanged, 30 minutes later when I passed on my return trip.  I raced home for my camera, sure he/she would be there when I returned.  In the meantime I had an elaborate fantasy (the kind of fantasy only a psychotherapist would have!) about that poor bird.  It went something like this:  The bird, probably young, had adapted to the stream at its lowest ebb during the summer.   Growing up beside a trickle, it was well adapted to those conditions.  When the stream swelled, her/his adaptation style no longer sufficed and he/she could not figure out what to do.

Of course, this reminded me of the essential human dilemma.  We adapt as children,  with brains, nimble and flexible,  to the conditions of our environment:  the family we are born into,  the emotional surround be it one of privation or abundance.  We are veritable geniuses of adaptation.  Problems arise latter when our brilliant adaptation styles no long suffice.  When the floods of later life come, we are often at a loss.  The tools of the earlier years are more than likely useless.

The child Holocaust survivor who starved and had to scrounge for whatever food was available in order to live,  may well have trouble at the dinner table as a middle aged adult now seated at the groaning board of American abundance: obesity and diabetes II ensue. The woman who has witnessed the suffering of older siblings who resisted a controlling parent only to be vilified, and rejected by that parent, learns submissiveness at home and fails to develop the assertiveness she needs to succeed in adult life.

I returned with my camera,  maybe 15 minutes later.  Mr. White Egret was gone.  There goes my theory.  Somehow he had navigated the falls.  Maybe he was just a patient fisherman all along.

Days passed,  no egret.  No egret, but another lesson came my way.

A week or two later, I had the good fortune to reconnect with a client I had known over many decades.  She was in her mid twenties (I in my mid thirties) when we met.  We worked together for many years and then just on and off thereafter.   She was in tough shape in those early years, nearly mute in our sessions for probably two years.  I did the talking, guessing at her pain, her shame, her fear.  She cancelled more often than not.   But often I could talk her into coming.  She had adapted well to an early environment in which it was dangerous to speak up,  it was dangerous to be noticed at all.  From a very large family, dominated by alcohol, violence, including sexual violence,  she was denigrated, humiliated, unprotected.   She felt insignificant, unsafe, and unworthy. 

Most significantly she was separated from herself—to survive  her childhood her essential self had gone into hiding.  What was left was a child hovering in fear, whatever strength there was seemingly defeated.   She was the only one among 17 children who had managed to finish high school,  but there was very little evidence of pride, and certainly no accolade from the family.  Any sign of independence, strength, intelligence was seen as a negative not a positive by her family.

Fast forward 20 years.  In the interim this woman went to college, gave birth and raised a child single handedly  and successfully without a father. She bought a home,  rose in her profession to a role of leadership,  survived a life threatening illness through sheer grit.  On and off she used therapy to help her navigate these crises, at times I was the second parent to her daughter, but for long stretches of time she did not call or come in to see me.

The one longing unfulfilled,  was the inability to sustain an intimate relationship with a man.

Now in her 50’s we are again back in touch and this time because she is in an intimate connection with a man, someone who sounds mature, loving, and accepting and who wants to marry her.  She knows she needs a little extra support until she decides what to do. 

The white egret has adapted to the falls.  A sustaining relationship with me over the years was certainly part of that critical adaptation.  But the real wonder here,  the awesome reality, is that she had the capacity to use that relationship and all other positives in her life, the terrific child she gave birth to,  her teachers in school,  friends, neighbors,  a few members of the extended family that did not put her down—whatever came her way she used to grow and change and reconnected with all that was positive in her. 

She herself has described it as the child within, the one I saw cowering in the early days mute and frightened, has grown up.

This is not the only story I have of the awe-inspiring nature of our ongoing, life-long capacity for change.  It’s just the latest.